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HOME TOWN PHARMACY LTC
DSH230038 Corewell Health Grand Rapids Hospitals Butterworth Hospital
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Covered Entity Details
Entity Name
Corewell Health Grand Rapids Hospitals Butterworth Hospital
Subdivision Name
BUTTERWORTH HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH230038
Entity Address
100 MICHIGAN STREET NE
GRAND RAPIDS, MI 49503-2560
Medicare Provider Number
230038
Participating Start Date
4/1/2004
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
HOME TOWN PHARMACY LTC
Pharmacy Address
4382 14 MILE RD NE
ROCKFORD, MI 49341-7838
Pharmacy Comments
Contract Details
Approval Date
7/12/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/19/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Shawn Ulreich, VP Clinical Operations/CNE
(616) 391-1065
Contract Pharmacy Representative
Hometown Pharmacy Inc.
Jim Grice, Vice President
(231) 861-6900
Signed By Date
7/12/2013
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